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This study examined healthcare resource use (HCRU) for selected vaccine-preventable diseases (VPD) in secondary care in England.The hospital episode statistics (HES) dataset covering all secondary care interactions within the English National Health Service (NHS) from 2015 to 2021 was used to identify and track HCRU for patients with a primary or secondary diagnosis for pertussis and Haemophilus influenzae type b (Hib), or a primary diagnosis only for hepatitis B, diphtheria, poliomyelitis, or tetanus. The first documented diagnosis during the study period (01/04/2015-31/03/2021) was the index event.7,274 patients with a total of 5,554,343 patient-days (mean follow up 1,491 days) were included. The total number of hospital admissions was 27,092 and total inpatient cost was £4,987,770, with hepatitis B making up ∼80 % of this. Mean outpatient hospital appointments per patient were highest for tetanus (4.00), but total outpatient AE cost burden was highest for Hib (£643,343 [mean per attendance £144.57]). For patients 0-9 years of age (n = 1,917), pertussis (n = 1,547) and Hib (n = 313) were by far the most commonly coded diseases. Hepatitis B was the most common disease in adults of working age and Hib was most prevalent in adults of retirement age. Surprisingly, poliomyelitis was observed in the database potentially due to historic diagnoses and/or coding inaccuracy. Other discrepancies with surveillance data were noted.VPDs impose a large burden on the NHS, but there is potential to reduce this and improve public health by optimising vaccination schedules, improving access and ensuring high coverage rates.

Novel tools and methods for monitoring marine environments can improve efficiency but must not compromise long-term data records. Quantitative comparisons between new and existing methods are therefore required to assess their compatibility for monitoring. Monitoring of shallow water coral reefs is typically conducted using diver-based collection of benthic images along transects. Diverless systems for obtaining underwater images (e.g. towed-cameras, remotely operated vehicles, autonomous underwater vehicles) are increasingly used for mapping coral reefs. Of these imaging platforms, towed-cameras offer a practical, low cost and efficient method for surveys but their utility for repeated measures in monitoring studies has not been tested. We quantitatively compare a towed-camera approach to repeated surveys of shallow water coral reef benthic assemblages on fixed transects, relative to benchmark data from diver photo-transects. Differences in the percent cover detected by the two methods was partly explained by differences in the morphology of benthic groups. The reef habitat and physical descriptors of the site—slope, depth and structural complexity—also influenced the comparability of data, with differences between the tow-camera and the diver data increasing with structural complexity and slope. Differences between the methods decreased when a greater number of images were collected per tow-camera transect. We attribute lower image quality (variable perspective, exposure and focal distance) and lower spatial accuracy and precision of the towed-camera transects as the key reasons for differences in the data from the two methods and suggest changes to the sampling design to improve the application of tow-cameras to monitoring.

Background In the UK, annual influenza vaccination is currently recommended for adults aged 16–64 years who are in a clinical at-risk group. Despite recommendations, rates of vaccine uptake in the UK have historically been low and below national and international targets. This study aims to analyse vaccine uptake among adults in clinical at-risk groups from the 2015–2016 influenza season to the present. Methods A retrospective analysis of influenza vaccine coverage in the UK was conducted using data extracted from publicly available sources. Clinically at-risk individuals (as defined by Public Health England), including pregnant women, aged 16–64 years, were included in this study. Results Influenza vaccination coverage rates across the UK in adults aged 16–64 years in a clinical at-risk group have been consistently low over the past 5 years, with only 48.0, 42.4, 44.1 and 52.4% of eligible patients in England, Scotland, Wales and Northern Ireland receiving their annual influenza vaccination during the 2018–2019 influenza season. Influenza vaccine coverage was lowest in patients with morbid obesity and highest in patients with diabetes in 2018–2019. Coverage rates were below current national ambitions of ≥75% in all clinical risk groups. In these clinical at-risk groups, influenza vaccine coverage decreased between 2015 and 2019, and there was considerable regional variation. Conclusions Uptake of the influenza vaccine by adults aged 16–64 years in a clinical at-risk group was substantially below the national ambitions. As a result, many individuals in the UK remain at high risk of developing severe influenza or complications. Given that people who are vulnerable to COVID-19 are also at increased risk of complications from influenza, during the 2020–2021 season, there is a heightened need for healthcare professionals across the UK to address suboptimal vaccine uptake, particularly in at-risk patients. Healthcare professionals and policymakers should consider measures targeted at increasing access to and awareness of the clinical benefits of the influenza vaccine.

Background Current surveillance data suggests that vaccine coverage rates (VCRs) in children are declining, potentially contributing towards outbreaks of vaccine-preventable diseases at levels not commonplace in the UK in recent years. This observed decline in VCRs can be attributed to a number of reasons, one of which is the increasing momentum in vaccine hesitancy. Insights we have obtained from healthcare professionals (HCPs) demonstrated a paucity of accessible medical education specifically addressing this complex issue. This led Sanofi Pasteur to develop a contemporary, non-promotional ‘Vaccination Educational Initiative’ for HCPs, called Lumiere, part of which focuses on increasing vaccine confidence and addressing vaccine hesitancy. Objective Equip HCPs with evidence-based techniques which help them address the concerns of the public and improve vaccine confidence amongst patients. Method Five symposia were held across the UK. The faculty comprised both academic experts and specialist nurses with relevant clinical experience who presented proven techniques that can help increase vaccine confidence. Attendee feedback from the first symposium suggested additional examples on how to apply these techniques in clinical practice would be helpful. Subsequent symposia were modified to include real life cases. Summary of results The symposia attracted a total of 443 attendees of which 37% (162) completed evaluation forms. 92% of respondents rated the symposia as good or excellent with 93% indicating they would change clinical practice based on their learnings. From the initial roll out of Lumiere we have demonstrated that medical education can help support HCPs play an active role in restoring vaccine confidence.

Risk assessment and safety planning are considered a cornerstone of mental health practice, yet limited research exists into how mental health nurses conceptualize 'risk' and how they engage with risk assessment and safety planning. The aim of the present study was to explore mental health nurses' practices and confidence in risk assessment and safety planning. A self-completed survey was administered to 381 mental health nurses in Ireland. The findings indicate that nurses focus on risk to self and risk to others, with the risk of suicide, self-harm, substance abuse, and violence being most frequently assessed. Risk from others and 'iatrogenic' risk were less frequently considered. Overall, there was limited evidence of recovery-oriented practice in relation to risk. The results demonstrate a lack of meaningful engagement with respect to collaborative safety planning, the identification and inclusion of protective factors, and the inclusion of positive risk-taking opportunities. In addition, respondents report a lack of confidence working with positive risk taking and involving family/carers in the risk-assessment and safety-planning process. Gaps in knowledge about risk-assessment and safety-planning practice, which could be addressed through education, are identified, as are the implications of the findings for practice and research.

The red seaweed Asparagopsis taxiformis embodies five cryptic mitochondrial lineages (lineage 1-5) introduced worldwide as a consequence of human mediated transport and climate change. We compared globally collected mitochondrial cox2-3 intergenic spacer sequences with sequences produced from multiple Australian locations and South Korea to identify Asparagopsis lineages and to reveal cryptic introductions. We report A. taxiformis lineage 4 from Cocos (Keeling) Islands, Australia, and the highly invasive Indo-Pacific Mediterranean lineage 2 from South Korea and Lord Howe Island, Australia. Phylogeographic analysis showed a clear haplotype and geographic separation between western Australian and Great Barrier Reef (GBR) isolates belonging to the recently described lineage 5. The same lineage, however, was characterized by a substantial genetic and geographic break between the majority of Australian specimens and Asparagopsis collections from South Solitary Island, Southern GBR, Lord Howe Island, Kermadec Islands, Norfolk Island, New Caledonia and French Polynesia. The disjunct geographic distribution and sequence divergence between these two groups supports the recognition of a sixth cryptic A. taxiformis mitochondrial lineage. As climatic changes accelerate the relocation of biota and offer novel niches for colonization, periodic surveys for early detection of cryptic invasive seaweeds will be critical in determining whether eradication or effective containment of the aliens are feasible.

Risk assessment and safety planning are considered a cornerstone of mental health practice, yet limited research exists into how mental health nurses conceptualize 'risk' and how they engage with risk assessment and safety planning. The aim of the present study was to explore mental health nurses' practices and confidence in risk assessment and safety planning. A self-completed survey was administered to 381 mental health nurses in Ireland. The findings indicate that nurses focus on risk to self and risk to others, with the risk of suicide, self-harm, substance abuse, and violence being most frequently assessed. Risk from others and 'iatrogenic' risk were less frequently considered. Overall, there was limited evidence of recovery-oriented practice in relation to risk. The results demonstrate a lack of meaningful engagement with respect to collaborative safety planning, the identification and inclusion of protective factors, and the inclusion of positive risk-taking opportunities. In addition, respondents report a lack of confidence working with positive risk taking and involving family/carers in the risk-assessment and safety-planning process. Gaps in knowledge about risk-assessment and safety-planning practice, which could be addressed through education, are identified, as are the implications of the findings for practice and research.

Policy-driven Dynamic Spectrum Access (DSA) systems are emerging as one of the key technologies to enable the Department of Defense (DoD) to meet its increasing requirements for access to the electromagnetic spectrum. A key open issue surrounding deployment and continuing development of DSA systems concerns (1) the need to test and evaluate the performance of DSA in avoiding interference to itself and assigned incumbent users and (2) the performance of DSA network in the presence of various types of potential interference. In this paper we describe test framework and concepts to characterize performance of DSA-enabled policy-based radios. Our test framework includes tests to characterize the inherent interference-avoidance characteristics of DSA, such as the time to abandon a channel, as well as tests that address performance implications of a particular DSA policy. The test framework also provides for the ability to inject a relevant electromagnetic environment (EME). The proposed framework is flexible allowing for customization of the relevant test conditions, such as the EME, and facilitates simulation of typical communications events such as network formation and fragmentation.

The focus of this chapter is the renal system and the clinical skills that are associated with renal dysfunction. By the end of this chapter you will be knowledgeable in relation to these skills and your new knowledge will be underpinned by up-to-date evidence-based best practice. It is anticipated that you will be able to do the following once you have read and studied this chapter: ● Understand urine sampling techniques and urine testing methods and their significance in clinical practice. ● Understand the various procedures and investigations that the infant, child, or young person may have to endure for renal system evaluation. The urinary system is important in maintaining the correct water and electrolyte concentrations in the body. Waste products and excess water and ions are eliminated from the body in the urine. The kidneys are situated on either side of the vertebral column in the abdomen. The ureter, renal blood vessels, nerves, and lymphatics enter the kidney at a cleft on the medial side called the hilum. The adrenal gland lies on top of the kidney. The outside of each kidney is lined by: ● The renal capsule—a layer of collagen fibres. ● The adipose capsule—a layer of fat. ● The renal fascia—a layer of dense connective tissue. These three layers of tissue protect and support the kidney. The inside of each kidney contains an outer area (the cortex) and an inner area (the medulla). The cortex is lighter in colour compared to the dark reddish-brown medulla. The medulla contains cone-shaped areas of tissue called the medullary pyramids, which point towards the hilum. The cortex extends in between the medullary pyramids forming the renal columns. Urine forms at the tip of the pyramids (papillae) and drains into the minor calyx, then into a larger major calyx. Two or three major calyces join together to form the renal pelvis, a funnel-shaped chamber that leads into the ureter. Nephrons are the functional units of the kidney, the structures where urine is formed.